Corticosteroids are commonly used as a treatment for radicular pain originating from cervical or lumbar disc disease and spondylosis. They are effective in decreasing pain from nerve root irritation when administered orally or epidurally. Reports of potential severe reactions to intrathecal use of Depo-Medrol has led to this use being classified as contraindicated by the FDA. Such use has been associated with the development of arachnoiditis and chronic pain. The preservatives in the formulation of Depo-Medrol, specifically benzyl alcohol and polyethylene glycol, are thought to be the causative agents. Administration of Depo-Medrol to the “exposed nerve rootlets” of a nerve root with an unrepaired dural tear is direct administration of the medication into the intrathecal space. The nerve rootlets are, by definition, intrathecal and are grouped together within the dural of the nerve root sleeve to become the nerve root.
Intrathecal depomedrol medical expert witness specialties include forensic pathology, radiology, oncology, and pediatric oncology.